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Underground Storage Tank <br />Monitoring System Certification Form <br />7. LINE LEAK DETECTOR TESTING <br />L1 Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) <br />Simulated release rate verified: (Check all that apply.) <br />A 3 GPH L 0.1 GPH Ll 0.2 GPH <br />Yes <br />No <br />NA <br />Has the testing apparatus been properly calibrated? <br />Line 1 <br />0 <br />Ll <br />For emergency generator tank systems, does the LLD create an audible and visual <br />alarm when a leak is detected? <br />FE Petro MLD -D <br />Line 2 <br />171 <br />For mechanical LLDs, does the LLD restrict the how through the pipe when a <br />release is detected? <br />® <br />1-1 <br />For electronic LLDs, does the turbine automatically shut of( when a release is <br />detected? <br />Ll <br />Ll <br />For electronic LLDs, does the turbine automatically shut off if any portion of the <br />monitoring system is disabled or disconnected? <br />J <br />Lj <br />P1 <br />For electronic LLDs, does the turbine automatically shut off if any portion of the <br />monitoring system malfunctions or fails a tightness test? <br />Ll <br />11 <br />Ll <br />For electronic LLDs, have all accessible wiring connections been visually inspected <br />for kinks and breaks? <br />Ll <br />Ll <br />Li <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />® <br />Ll <br />Ll <br />Were all LLDs confirmed operational within regulatory requirements? <br />0 <br />Lj <br />L] <br />LLD ID <br />LLD Model <br />Lines Monitored <br />Pass <br />Fail <br />T1 <br />FE Petro MLD -D <br />Line 1 <br />0 <br />Ll <br />T1 <br />FE Petro MLD -D <br />Line 2 <br />0 <br />Ll <br />Ll <br />Ll <br />Ll <br />Ll <br />Ll <br />Li <br />Li <br />Ll <br />Ll <br />Lj <br />Ll <br />Ll <br />L) <br />Ll <br />Ll <br />L1 <br />0 <br />® <br />L1 <br />Describe all answers marked "No" or "Fail" and proposed remedy ir7 Sectiora 9. <br />List all monitoring equipment either replaced or repaired in Section 9 <br />Page 4 of 6 <br />